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Premenstrual Dysphoric Disorder, or PMDD, is a severe form of PMS. Like PMS, PMDD occurs the week before the onset of menstruation and disappears a few days after. PMDD is characterized by severe monthly mood swings and physical symptoms that interfere with everyday life, especially a woman's relationships with her family and friends. PMDD symptoms go far beyond what are considered manageable or normal premenstrual symptoms.
Symptoms
PMDD's symptoms that may include irritability, a depressed mood, anxiety, sleep disturbance, difficulty concentrating, angry outbursts, breast tenderness and bloating. The diagnostic criteria emphasize symptoms of depressed mood, anxiety, mood swings or irritability. The condition affects up to 5 percent of American women who have regular menstrual periods. The symptoms of PMDD may resemble other conditions or medical problems, such as a thyroid condition, depression or an anxiety disorder. Consult a physician for a diagnosis.
Complications
Women who have a history of depression are at increased risk for PMDD. Similarly, women who have had PMDD are at increased risk for depression after menopause. Patients with severe PMDD may be more at risk of developing postpartum depression than other women. Furthermore, women who have been otherwise successfully treated with antidepressants often show breakthrough symptoms of depression in the premenstrual phase of their menstrual cycle.
Cause
The exact cause of PMDD is unknown, although as with other mood disorders, there's speculation that the neurotranmitter serotonin may be involved. In PMDD, this imbalance may be related to your monthly changes in hormones. Women who experience PMDD seem to have abnormal reactions to normal hormone changes that occur with each menstrual cycle. Additional research is necessary.
Diagnosis
Diagnostic procedures for PMDD are currently very limited. Your physician may consider recommending a psychiatric evaluation to rule out other possible conditions. In addition, he may ask that you keep a journal or diary of your symptoms for several months, to better assess the timing, severity, onset and duration of symptoms. In general, in order for a PMDD diagnosis to be made, symptoms must be present over the course of a year, during most menstrual cycles.
What Is the Difference Between PMS and PMDD?
The physical symptom list is identical for PMS and PMDD; and, although the emotional symptoms are similar, they are significantly more serious with PMDD. In PMDD, the mood disorder, rather than the physical symptoms, are most prominent and disruptive. With PMS, sadness or mild depression is not uncommon, but with PMDD, significant depression and hopelessness may occur. In extreme cases, women may feel like killing themselves or others. These feelings must be taken as seriously as they are in anyone else, and should be brought promptly to the attention of a mental-health professional.
Treatment
Antidepressants, especially the SSRIs, have been found to be effective in the treatment of PMDD. Fluoxetine, sertraline, and paroxetine are commonly prescribed for the condition. Antidepressants, however, can also increase the risk of suicidal thinking and behavior in children and teenagers who suffer from depression and other psychiatric disorders. Patients starting therapy should be observed closely for worsening depression symptoms, suicidal thoughts or behavior, or unusual changes in behavior.
People on antidepressants and their families should watch for these symptoms and call their doctor if they are severe or occur suddenly, especially at the beginning of treatment or whenever there is a change in dosage.
Most antidepressant medications will produce side effects. Some women may experience headache, upset stomach, tiredness, insomnia, nervousness, dizziness and difficulty concentrating. Side effects are usually mild and tend to go away within a few weeks.
For some women, hormonal therapies are necessary to suppress the menstrual cycle altogether. For some women, the severity of symptoms increases over time and lasts until menopause. For this reason, a woman may require treatment for an extended period of time, and may require several re-evaluations to adjust medication dosages throughout the course of treatment.
If you think you have PMDD, find a doctor who is familiar with PMDD or get a second opinion from another OB/GYN or psychiatrist.
